I think that splenectomy at the same time of liver transplant is the way to go since she has had relapsed ITP after steroids and rituximab . I would consider thrombopoietin agents after that , if necessary .
David Sumoza , MD John H . Stroger , Jr . Hospital
Chicago , IL
It takes a while to find a transplant . I would give her romiplostim or eltrombopag until an appropriate donor liver is found . She probably does not need a splenectomy as she will be on immunosuppression after her liver transplant .
Steven Sandler , MD Advocate Illinois Masonic Medical Center
Skokie , IL
Rituximab has proven useful in this kind of patient . Splenectomy can be considered when liver transplant is decided .
Arturo Mario Musso , MD Hospital Militar Central Buenos Aires , Argentina
See more reader responses at ashclinicalnews . org / you-makethe-call .
See Final OS Data Analysis
WHEN MULTIPLE MYELOMA RELAPSES ,
Don ’ t put your patient ’ s survival at risk
KYPROLIS ® -based regimens ( KRd and Kd ) reduced the risk of death by 21 % vs Rd and Vd and extended median overall survival by 7.9 and 7.6 months , respectively 1 , * ,†,‡,§
KRd |
AS A TRIPLET THERAPY |
Kd |
AS A DOUBLET THERAPY |
8.7-month increase in median PFS 1
26.3 months ( KRd ) vs 17.6 months ( Rd ); hazard ratio ( KRd / Rd ) = 0.69 ( 95 % CI : 0.57-0.83 ); two-sided P = 0.0001
7.9-month increase in median OS 1
* 48.3 months ( KRd ) vs 40.4 months ( Rd ); hazard ratio ( KRd / Rd ) = 0.79 ( 95 % CI : 0.67-0.95 ); two-sided P = 0.0091
> 3x CR or better 1
32 % ( KRd ) vs 9 % ( Rd )
†
KRd vs Rd Phase 3 design : N = 792 , randomized ( 1:1 ), open-label superiority study comparing KRd vs Rd in relapsed or refractory multiple myeloma patients who had received 1 to 3 lines of therapy . The primary endpoint was progression-free survival . Select secondary endpoints included overall survival and overall response rate . KYPROLIS ® was discontinued per protocol in the KRd arm after 18 cycles of treatment . 1 , 2
9.3-month increase in median PFS 1
18.7 months ( Kd ) vs 9.4 months ( Vd ); hazard ratio ( Kd / Vd ) = 0.53 ( 95 % CI : 0.44-0.65 ); one-sided P < 0.0001
7.6-month increase in median OS 1
‡
47.6 months ( Kd ) vs 40.0 months ( Vd ); hazard ratio ( Kd / Vd ) = 0.79 ( 95 % CI : 0.65-0.96 ); one-sided P = 0.01
§
Kd vs Vd Phase 3 design : N = 929 , randomized ( 1:1 ), open-label superiority study comparing Kd to Vd in relapsed or refractory multiple myeloma patients who had received 1 to 3 lines of therapy . The primary endpoint was progression-free survival . Overall survival was a prespecifi ed key secondary effi cacy endpoint . 1 , 3
See more OS results at KYPROLIS-HCP . com
CI = confi dence interval ; CR = complete response ; Kd = KYPROLIS ® and dexamethasone ; KRd = KYPROLIS ® , lenalidomide , and dexamethasone ; OS = overall survival ; PFS = progression-free survival ; Rd = lenalidomide and dexamethasone ; Vd = VELCADE ® ( bortezomib ) and dexamethasone .
IMPORTANT SAFETY INFORMATION FOR KYPROLIS
Cardiac Toxicities : New onset or worsening of pre-existing cardiac failure ( e . g ., congestive heart failure , pulmonary edema , decreased ejection fraction ), restrictive cardiomyopathy , myocardial ischemia , and myocardial infarction including fatalities have occurred following administration of KYPROLIS . Some events occurred in patients with normal baseline ventricular function . Death due to cardiac arrest has occurred within one day of administration .
Please see additional Important Safety Information on left .
References : 1 . KYPROLIS ® ( carfi lzomib ) prescribing information , Onyx Pharmaceuticals Inc ., an Amgen Inc . subsidiary . 2 . Siegel DS , Dimopoulos MA , Ludwig H , et al . Improvement in overall survival with carfi lzomib , lenalidomide , and dexamethasone in patients with relapsed or refractory multiple myeloma . J Clin Oncol . 2018 ; 36:728-734 . 3 . Dimopoulos MA , Goldschmidt H , Niesvizky R , et al . Carfi lzomib or bortezomib in relapsed or refractory multiple myeloma ( ENDEAVOR ): an interim overall survival analysis of an open-label , randomised , phase 3 trial . Lancet Oncol . 2017 ; 18:1327-1337 .
VELCADE ® is a registered trademark of Millennium Pharmaceuticals .
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